Provider Demographics
NPI:1023512886
Name:MOSS, CHAVON D
Entity type:Individual
Prefix:
First Name:CHAVON
Middle Name:D
Last Name:MOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-5414
Mailing Address - Country:US
Mailing Address - Phone:434-213-5456
Mailing Address - Fax:434-333-4125
Practice Address - Street 1:604 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-5414
Practice Address - Country:US
Practice Address - Phone:434-213-5456
Practice Address - Fax:434-333-4125
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA60409034347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle